Uchechukwu C Megwalu, Yifei Ma, Vasu Divi, Lu Tian
{"title":"头颈癌生存中种族差异的中介因素。","authors":"Uchechukwu C Megwalu, Yifei Ma, Vasu Divi, Lu Tian","doi":"10.1002/lary.70107","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and quantify the mediation effects of neighborhood socioeconomic status (SES), insurance status, and quality of care on racial disparities in HNC survival.</p><p><strong>Methods: </strong>Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Mediators included insurance status, SES, hospital quality, and National Comprehensive Cancer Network (NCCN) guideline-compliant care.</p><p><strong>Results: </strong>Black patients (HR 1.14, 95% CI 1.05-1.24) had worse OS compared with White patients after adjusting for demographic, clinical, and treatment factors. SES accounted for 49.0% (95% CI 13.1%-84.8%) of the disparity. Health insurance (commercial: 21.9% (95% CI 12.3%-38.4%), Medicaid: 19.7% (95% CI 10.1%-45.4%)), hospital quality (high-quality: 5.1% (95% CI 2.1%-9.3%), low-quality: 4.9% (95% CI 1.2%-9.8%)), and guideline-compliant care (10.9% (95% CI 3.2%-23.6%)) also mediated the disparity. Asian/Pacific Islander patients (HR 1.26, 95% CI 1.10-1.43) had worse DSS. Health insurance had a small mediation effect (commercial: 3.0% (95% CI 1.0%-6.6%), Medicaid: 5.1% (95% CI 2.1%-8.9%)), while SES, hospital quality, and guideline-compliant care did not.</p><p><strong>Conclusions: </strong>SES, insurance status, and quality of care mediate racial disparities in HNC survival. These findings suggest that health system and policy interventions targeting SES, insurance reform, and quality of care may lead to reductions in HNC disparities.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mediators of Racial Disparities in Head and Neck Cancer Survival.\",\"authors\":\"Uchechukwu C Megwalu, Yifei Ma, Vasu Divi, Lu Tian\",\"doi\":\"10.1002/lary.70107\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate and quantify the mediation effects of neighborhood socioeconomic status (SES), insurance status, and quality of care on racial disparities in HNC survival.</p><p><strong>Methods: </strong>Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Mediators included insurance status, SES, hospital quality, and National Comprehensive Cancer Network (NCCN) guideline-compliant care.</p><p><strong>Results: </strong>Black patients (HR 1.14, 95% CI 1.05-1.24) had worse OS compared with White patients after adjusting for demographic, clinical, and treatment factors. SES accounted for 49.0% (95% CI 13.1%-84.8%) of the disparity. Health insurance (commercial: 21.9% (95% CI 12.3%-38.4%), Medicaid: 19.7% (95% CI 10.1%-45.4%)), hospital quality (high-quality: 5.1% (95% CI 2.1%-9.3%), low-quality: 4.9% (95% CI 1.2%-9.8%)), and guideline-compliant care (10.9% (95% CI 3.2%-23.6%)) also mediated the disparity. Asian/Pacific Islander patients (HR 1.26, 95% CI 1.10-1.43) had worse DSS. Health insurance had a small mediation effect (commercial: 3.0% (95% CI 1.0%-6.6%), Medicaid: 5.1% (95% CI 2.1%-8.9%)), while SES, hospital quality, and guideline-compliant care did not.</p><p><strong>Conclusions: </strong>SES, insurance status, and quality of care mediate racial disparities in HNC survival. These findings suggest that health system and policy interventions targeting SES, insurance reform, and quality of care may lead to reductions in HNC disparities.</p><p><strong>Level of evidence: 3: </strong></p>\",\"PeriodicalId\":49921,\"journal\":{\"name\":\"Laryngoscope\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laryngoscope\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/lary.70107\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/lary.70107","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
摘要
目的：评估和量化社区社会经济地位（SES）、保险状况和护理质量对HNC生存种族差异的中介作用。方法：回顾性队列研究来自加利福尼亚癌症登记数据集的数据，该数据集与加利福尼亚卫生保健获取和信息部的出院记录和医院特征相关联。该研究队列包括2010年1月1日至2019年12月31日期间诊断为HNC的成年患者。中介因素包括保险状况、SES、医院质量和国家综合癌症网络（NCCN）指南依从性护理。结果：在调整了人口统计学、临床和治疗因素后，黑人患者（HR 1.14, 95% CI 1.05-1.24）的OS比白人患者更差。SES占差异的49.0% （95% CI 13.1%-84.8%）。健康保险(商业保险：21.9% (95% CI 12.3%-38.4%)，医疗补助：19.7% (95% CI 10.1%-45.4%))，医院质量(高质量：5.1% （95% CI 2.1%-9.3%)，低质量：4.9% (95% CI 1.2%-9.8%)）和指南依从性护理（10.9% (95% CI 3.2%-23.6%)）也介导了差异。亚洲/太平洋岛民患者（HR 1.26, 95% CI 1.10-1.43）的DSS更差。健康保险具有较小的中介效应(商业：3.0% (95% CI 1.0%-6.6%)，医疗补助：5.1% (95% CI 2.1%-8.9%))，而社会经济地位、医院质量和指南依从性护理则没有。结论：社会经济地位、保险状况和护理质量介导HNC生存的种族差异。这些发现表明，针对社会经济地位、保险改革和护理质量的卫生系统和政策干预可能导致高收入人口差距的缩小。证据等级：3；
Mediators of Racial Disparities in Head and Neck Cancer Survival.
Objective: To evaluate and quantify the mediation effects of neighborhood socioeconomic status (SES), insurance status, and quality of care on racial disparities in HNC survival.
Methods: Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Mediators included insurance status, SES, hospital quality, and National Comprehensive Cancer Network (NCCN) guideline-compliant care.
Results: Black patients (HR 1.14, 95% CI 1.05-1.24) had worse OS compared with White patients after adjusting for demographic, clinical, and treatment factors. SES accounted for 49.0% (95% CI 13.1%-84.8%) of the disparity. Health insurance (commercial: 21.9% (95% CI 12.3%-38.4%), Medicaid: 19.7% (95% CI 10.1%-45.4%)), hospital quality (high-quality: 5.1% (95% CI 2.1%-9.3%), low-quality: 4.9% (95% CI 1.2%-9.8%)), and guideline-compliant care (10.9% (95% CI 3.2%-23.6%)) also mediated the disparity. Asian/Pacific Islander patients (HR 1.26, 95% CI 1.10-1.43) had worse DSS. Health insurance had a small mediation effect (commercial: 3.0% (95% CI 1.0%-6.6%), Medicaid: 5.1% (95% CI 2.1%-8.9%)), while SES, hospital quality, and guideline-compliant care did not.
Conclusions: SES, insurance status, and quality of care mediate racial disparities in HNC survival. These findings suggest that health system and policy interventions targeting SES, insurance reform, and quality of care may lead to reductions in HNC disparities.
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
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